The Impact of HIV on Transmission of Tuberculosis in Ugandan Households

To examine the effect of HIV infection old infectiousness of TB. Design: Cross-sectional prevalence study of household contacts to smear positive TB patients. Methods: HIV-infected and non-infected index TB cases with sputum smear positive TB; were enrolled from a major TB clinic at Mulago Hospital in Kampala; Uganda. All full-time household contacts of the index cases were evaluated by: medical history and physical examination; Mantoux purified protein derivative (PPD) skin tests; chest x-ray; BCG vaccination status; HIV test (in consenting subjects); TB symptoms and demographic and household environment. a contact with signs and/or symptoms of TB underwent a complete work-up for active TB. The main outcome measures were PPD positively and active TB. APPD skin-test readingor=5mm was considered positive. Results: 699 contacts of 170 index TB cases were included in this analysis. 319 (46) were contacts of 82 HIV+index TB cases. No significant differences were noted in the proportion of PPD positively; between contacts of HIV-infected and those pf the HIV-non-infected index cases [79versus 79; P=0.984]. Risk factors for PPD-positivity in contacts were: AFB smear grade of the index case [Odds Ratio (OR) = 1.7; 95CI: 1.16-2.37]; cavitary disease in the index case [OR=5.9; 95CI: 2.53-14.0]; age of the contact [OR = 1.1; 95CI: 1.05-1.10]; and household size [OR=0.9;95CI:0.85-0.96]. Risk factors for active TB in contacts were: cavitary disease in the index case [OR = 2.0;95CI: 1.07-3.58]; age of the contact [OR = 1.1; 95CI:0.89-0.96]; HIV status of the contact [OR=5.9;95CI:1.69-21.9]; and sharing of bed or bedroom with the index case [OR=2.5; 95CI: 1.54-3.92]. Conclusion: Transmission of M. tuberculosis within households was comparable among HIV-infected and non-infected index TB cases. However; transmission differed depending on: whether the index case had cavitary disease; the sputum AFB smear; household sixe and age of the contact. HIV-infected contacts; children and intimate contacts of the index cases were at increased risk of having active TB at the time of household evaluation

Clinical complications of malaria in Uganda children presenting to an emergency unit

To determine the major complications of malaria in children presenting to the Acute Care Unit; Mulago Hospital; Kampala; Uganda. METHODS: 148 charts of children admitted to the Acute Care Unit; with laboratory confirmed malaria were retrospectively reviewed; documenting clinical complications; haemoglobin estimation; level of parasitemia and treatment given. Thirty five children (24) had no documented complication and were excluded from the analysis. RESULTS: The median age for the 113 children analysed was 1.5 years (3 months - 12 yrs.) Eighty percent of the children were 3 years of age. The major clinical complications were severe anaemia in 58.4(66/113); febrile convulsions in 31.8(36/113); and cerebral malaria in 29.2(33/113) of the children. The median age for presentation were 11 months (3 months-6yrs) for severe anaemia; 1.3 years (4 months - 6 yrs) for febrile convulsions and 2 yrs (5 months - 12 years) for cerebral malaria. The children with severe anemia (Hb6g/dl) had a mean hemoglobin of 5.0g/dl (range 2.8-6.0g/dl). The level of parasitemia was highest in those children over 4 years; however; this was not statistically significant due to the small numbers. The treatment with chloroquine was documented in 57.5of the episodes; guinine in 43.1and both in 6.5. Chloroquine alone was used more frequently in those children less than 1 year and quinine in those over 2 years. This is related to the almost exclusive use of quinine in cerebral malaria patients. Conclusion: Malaria occurred most frequently in children under 3 years of age. The main complication in this group of Ugandan children was severe anemia. Age was the major predictor of each complication as well as treatment given. Malaria in children needs to be aggressively managed to avoid these complications